Quality & Oversight Analyst

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

Location: Candidate must reside in the state of Maryland

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.

The Opportunity:

The Quality Analyst for the Quality oversight team is responsible for preparing, inspecting, and complying with contractual quality program requirements. In this role you will validate and/or develop improved standards, identify training needs, including root-cause analysis, and correction actions/recommend solutions for the Quality oversight department within Compliance.

How you will contribute:

• Conduct comprehensive quality assurance assessments and audits to identify deviations, defects and non-conformities with processes and service level metrics. Report deficiencies to management.

• Develop and implement quality control audit plans.

• Training employees on quality standards and procedures.

• Preparing and presenting quality reports to senior management.

• Track and trend root cause analysis and corrective actions to address quality issues.

• Maintain quality meeting minutes for client distribution.

• Attending and participate in client meetings.

• Track quality contractual requirements and insure compliance of such requirements.

What you will bring with you:

• Solid understanding of NCQA and/or URAC requirements.

• Detail oriented and organized with the ability to prioritize tasks and meet deadlines.

• Strong analytical and problem-solving skills with the ability to conduct root cause analysis and implement corrective actions.

• Accountable for contributing to a workplace environment that fosters mutual respect, cooperation, information sharing and commitment to delivering the expected service.

• Broad knowledge of Medicaid administration. 

• Knowledge of federal and state laws/regulations applicable to quality and processes

• Ability to think creatively to resolve the more complex or non-routine issues.

• Strong written and verbal communication skills and experience.

• Ability to effectively coach, develop and motivate team member to achieve Department and SLF goals

• Strong negotiation, decision making and problem-solving skills and experience

• Ability to develop and maintain effective, professional business relationships across all levels of the organization and external TPA administrators and customers

• Strong PC Proficiency

• Ability to successfully meet deadlines and achieve goals

• Knowledge of company computer systems and products a strong

Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!

Life is brighter when you work at Sun Life

• Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more

• Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account

• A flexible work environment with a friendly, caring, collaborative and inclusive culture

• Great Place to Work® Certified in Canada and the U.S.

• Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Salary Range: $50,500 - $75,800

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.com to request an accommodation.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

Customer Service / Operations29/06/2025

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.